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Background: The aim of this study is to evaluate the outcomes and prognostic factors in patients with hepatocellular carcinoma (HCC) and Child–Turcotte–Pugh (CTP) class B liver function after stereotactic ablative radiotherapy (SABR). Materials and Methods: This retrospective study evaluated patients with HCC and impaired liver function who underwent SABR between December 2007 and August 2016. All patients had CTP class B liver function before treatment. Local control (LC) rate, overall survival (OS) rate, prognostic factors, and radiation-related toxicity were evaluated. Results: This study included 34 patients. The majority had a CTP score of B7 (52.9%) and advanced HCC (91.2%). The median survival time was 4.8 months, and the 1-year OS rate was 21.4%. Only the tumor number (multiple vs. single) was identified as an independent predictor of survival. The 1-year LC rate was 95.8%. Eight patients (23.5%) developed the radiation-induced liver disease, and 15 (44.1%) had a CTP score decline of ≥2 within 3 months. Other toxicities were generally tolerable. Conclusion: SABR may be considered as an alternative option for patients with HCC and CTP class B liver function, particularly for those with a single lesion.

PURPOSE The objective of this study was to determine whether pretreatment neutrophil-to-lymphocyte ratio (NLR) could predict survival outcomes and liver toxicity in hepatocellular carcinoma (HCC) patients treated with stereotactic ablative radiation therapy (SABR). METHODS AND MATERIALS In this retrospective study we collected pretreatment NLR of HCC patients treated with SABR between December 2007 and August 2018 and determined its association with overall survival (OS), progression-free survival, and radiation-related liver toxicity defined as an increase in the Child-Turcotte-Pugh score by ≥2 within 3 months after SABR in the absence of disease progression. RESULTS A total of 153 patients with a median follow-up of 13.3 months were included. Receiver operating characteristic curve analysis found that an NLR ≥2.4 was optimum (area under the curve, 0.762; 95% confidence interval [CI], 0.682-0.841, P < .001) for predicting poor 1-year OS (38.2% vs 83.6%, P < .001). Multivariable analysis demonstrated that NLR was significantly associated with OS, both as a continuous (P = .006) and a binary variable (NLR set at 2.4; P = .003). Multiple tumors (P = .003), macrovascular invasion (P = .024), extrahepatic spread (P = .002), and albumin-bilirubin score (P = .020) were also significant predictors of OS. Elevated NLR independently prognosticated poor progression-free survival (P = .016). Liver toxicity was seen in 22 evaluable patients (15.4%). Receiver operating characteristic curve analysis found NLR ≥4.0 was optimum at predicting liver toxicity (31.4% vs 10.2%, P = .005). A higher NLR (P = .049) and albumin-bilirubin score (P = .002) were independent risk factors for liver toxicity. CONCLUSIONS NLR is an objective and ubiquitous inflammatory marker that can predict OS and liver toxicity in HCC patients undergoing SABR. NLR could be a useful biomarker for patient risk stratification and therapeutic decision-making.

Background Few studies have focused on DNA methylation in endometrial cancer. The aim of our study is identify its role in endometrial cancer prognosis. Methods A publicly available dataset was retrieved from The Cancer Genome Atlas. For validation of expression alteration due to methylation, RNA sequencing data were obtained from other independent cohorts. MethSurv was used to search for candidate CpG probes, which were then filtered by least absolute shrinkage and selection operator Cox regression and multivariate Cox regression analyses to identify final set of CpG probes for overall survival. A methylation-based risk model was developed and receiver operating characteristic analysis with area under curve was used for evaluation. Patients were divided into high- and low-risk groups using an optimal cut-off point. Comprehensive bioinformatic analyses were conducted to identify hub genes, key transcription factors, and enriched cancer-related pathways. Kaplan–Meier curve was used for survival analysis. Results A 5-CpG signature score was established. Its predictive value for 5-year overall survival was high, with area under curve of 0.828, 0.835 and 0.816 for the training, testing and entire cohorts. cg27487839 and cg12885678 had strong correlation with their gene expression, XKR6 and PTPRN2, and lower PTPRN2 expression was associated with poorer survival in both The Cancer Genome Atlas and the validation datasets. Low-risk group was associated with significantly better survival. Low-risk group harboured more mutations in hub genes and key transcription factors, and mutations in SP1 and MECP2 represented favourable outcome. Conclusion We developed a methylation-based prognostic stratification system for endometrial cancer. Low-risk group was associated with better survival and harboured more mutations in the key regulatory genes.

Chih-Weim Hsiang,1 Wen-Yen Huang,2,3 Jen-Fu Yang,2 Po-Chien Shen,2 Yang-Hong Dai,2 Ying-Fu Wang,2 Chun-Shu Lin,2 Wei-Chou Chang,1 Cheng-Hsiang Lo2 1Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 2Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 3Institute of Clinical Medicine, National Yang-Ming University, Taipei, TaiwanCorrespondence: Cheng-Hsiang LoDepartment of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, No. 325, Sec 2, Cheng-Gong Road, Neihu, Taipei, 114, TaiwanTel +886-2-87927122Fax +886-2-66002357Email lsir183@yahoo.com.twPurpose: Immune response to antitumor therapies has been correlated with oncologic outcomes. This study aimed to determine whether dynamic changes in immune parameters could predict survival outcomes and assess their relationship with liver toxicity in hepatocellular carcinoma (HCC) patients treated with stereotactic body radiation therapy (SBRT).Methods: Data on pre- and post-SBRT (within 3 months) peripheral blood cell counts, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were retrospectively collected. Kinetic changes in these immune parameters and delta-NLR (dNLR) and delta-PLR (dPLR) in response to SBRT were evaluated. Overall survival (OS) and progression-free survival (PFS) were compared based on baseline NLR/PLR and dNLR/dPLR. Additionally, the association of these dynamic measures with liver toxicity was determined.Results: The study included 93 patients with a median 10.7-month follow-up. Significant increases in NLR (p< 0.001) and PLR (p=0.003) were observed after SBRT. In the multivariable analysis, elevated pre-SBRT NLR (p< 0.001) and dNLR (p=0.011) were predictive of worse OS. dNLR was not associated with PFS. Neither PLR nor dPLR was predictive of survival outcomes. Patients with Child–Turcotte–Pugh class B had higher dNLR and greater risk of liver toxicity than class A counterparts. Receiver operating characteristic curve analysis found that dNLR ≥ 1.9 was an optimal cut-off value for determining liver toxicity risk (35.1% vs 7.5%, p=0.002).Conclusion: Baseline NLR and dNLR can complementarily predict OS in HCC patients treated with SBRT. Elevated dNLR is associated with worse OS and development of liver toxicity, possibly through their relationship with baseline liver function. Dynamic changes in NLR should be monitored in HCC care.Keywords: hepatocellular carcinoma, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, stereotactic body radiotherapy, liver toxicity

Background This study aimed to compare the clinical outcomes of stereotactic ablative radiotherapy (SABR) and conventionally fractionated radiotherapy (CFRT) in hepatocellular carcinoma (HCC) patients with portal vein invasion (PVI). Methods HCC patients with PVI treated with radiotherapy from 2007 to 2016 were analysed. CFRT was administered at a median dose of 51.5 Gy (interquartile range, 45–54 Gy) with 1.8–3 Gy per fraction. SABR was administered at a median dose of 45 Gy (interquartile range, 40–48 Gy) with 6–12.5 Gy per fraction. Treatment efficacy, toxicity, and associated predictors were assessed. Results Among the 104 evaluable patients (45 in the SABR group and 59 in the CFRT group), the overall response rate (ORR, complete and partial response) was significantly higher in the SABR group than the CFRT group (62.2% vs. 33.8%, p = 0.003). The 1-year overall survival (OS) rate (34.9% vs. 15.3%, p = 0.012) and in-field progression-free survival (IFPS) rate (69.6% vs. 32.2%, p = 0.007) were also significantly higher in the SABR vs. CFRT group. All 3 rates remained higher in the SABR group after propensity score matching. Multivariable analysis identified SABR and a biologically effective dose ≥65 Gy as favourable predicators of OS. There was no difference between treatment groups in the incidence of radiation-induced liver disease or increase of Child-Pugh score ≥ 2 within 3 months of radiotherapy. Conclusions SABR was superior to CFRT in terms of ORR, OS, and IFPS. We suggest that SABR should be the preferred technique for HCC patients with PVI.

This study compared the local control and overall survival (OS) between stereotactic body radiation therapy (SBRT) and transarterial chemoembolization (TACE) in medium-sized (3-8 cm) hepatocellular carcinoma (HCC).From January 2008 to October 2017, 188 patients with medium-sized HCC underwent either TACE (n = 142) or SBRT (n = 46). We adjusted for imbalances in treatment assignment using propensity score matching. Infield control (IFC) and OS were analyzed retrospectively.The median follow-up time was 17.1 months for all patients and 26.6 months for surviving patients. The 3-year IFC was 63.0% for the TACE group and 73.3% for the SBRT group. Multivariable analysis identified the independent predictors for IFC as treatment modality (SBRT vs TACE), sex (female vs male), and recurrence status (recurrence vs new diagnosis). The 3-year OS was 22.9% for the TACE group and 47.4% for the SBRT group. Multivariable analysis identified the independent predictors of OS as number of tumors, treatment modality (SBRT vs TACE), albumin-bilirubin grade, tumor volume, Eastern Cooperative Oncology Group status, and recurrence status. Propensity score matching analysis revealed that the SBRT group had better IFC (3-year IFC of 77.5% vs 55.6%; P = .007) and OS (3-year OS of 55.0% vs 13.0%; P.001) than the TACE group. For recurrent HCC, the SBRT group exhibited superior IFC (3-year IFC of 75% vs 57.5%; P = .022) and OS (3-year OS of 58.3% vs 5.9%; P.001) compared with the TACE group. However, there was no difference in IFC or OS between TACE and SBRT for patients with newly diagnosed HCC.SBRT has better IFC and OS rates than TACE in patients with medium-sized HCC, particularly for recurrent cases, which warrants prospective randomized controlled trials of TACE and SBRT.

Background Genomic profiles of specific gene sets have been established to guide personalized treatment and prognosis for patients with breast cancer (BC). However, epigenomic information has not yet been applied in a clinical setting. ST14 encodes matriptase, a proteinase that is widely expressed in BC with reported prognostic value. Methods In this present study, we evaluated the effect of ST14 DNA methylation (DNAm) on overall survival (OS) of patients with BC as a representative example to promote the use of the epigenome in clinical decisions. We analyzed publicly available genomic and epigenomic data from 1361 BC patients. Methylation was characterized by the β-value from CpG probes based on sequencing with the Illumina Human 450 K platform. Results A high mean DNAm (β > 0.6779) across 34 CpG probes for ST14, as the gene-associated methylation (GAM) pattern, was associated with a longer OS after adjusting age, stage, histology and molecular features in Cox model (p value XBP1 expression level and higher proportion of hormone-positive BC (p value Conclusions Here we show the potential role of ST14 DNAm in BC prognosis and warrant further study.

Additional file 1: Table S1: Prognostic factors influencing RFS and OS after LT using the Cox proportional hazards model.

Accurate assessment of the response to radiotherapy is essential to avoid missing the opportunity for early salvage treatment for residual tumors as well as overtreatment in complete responders. The evaluation of radiotherapy response in liver tumors mainly involves the interpretation of imaging studies. Dynamic contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) are the most widely used image evaluation tools. Enhancement-based imaging response evaluation criteria, such as the European Association for Study of the Liver (EASL) and the modified Response Evaluation Criteria in Solid Tumors (mRECIST), are more sensitive than the size change-based RECIST and World Health Organization (WHO) criteria. However, early assessment of the tumor response is challenging. Understanding the time frame of imaging changes of the tumor and surrounding irradiated liver parenchyma is essential for accurate assessment. The typical imaging changes of the tumor are gradual reduction in size of the enhancing part and increase of necrosis over time. The focal liver reaction of the irradiated peritumoral liver tissue also changes over time from hyperemia in acute phase to gradual returning to normal enhancement pattern in chronic phase. Thus, accurate response interpretation requires a series of follow-up contrast-enhanced images with careful assessment of consecutive changes. In this chapter, we describe the imaging assessment of radiotherapy response in liver tumors, focusing on hepatocellular carcinoma (HCC).

Background: Stereotactic body radiotherapy (SBRT) is an emerging modality for hepatocellular carcinoma (HCC). However, there is scant information about its safety and effectiveness in the neoadjuvant setting prior to liver transplantation (LT). We present the clinical outcome and pathologic assessment of SBRT followed by LT for patients with advanced HCC.Methods: This retrospective study included HCC patients treated with neoadjuvant SBRT prior to LT between 2009 and 2018. Radiographic response and adverse effects, including radiation-induced liver disease (RILD), were evaluated. Pathologic response was assessed by the percentage of tumor necrosis relative to the total tumor volume. Overall survival (OS) and recurrence-free survival (RFS) were calculated using the Kaplan–Meier method.Results: Fourteen patients underwent SBRT for a total of 25 HCC lesions, followed by LT. The median tumor size was 4.45 cm in diameter, and the median prescribed dose was 45 Gy in 5 fractions. SBRT provided significant AFP reduction, 100% infield control, and a 62.5% response rate. The maximum detected toxicity included grade 3 thrombocytopenia and two grade 3–4 hyperbilirubinemia. One patient developed non-classic RILD. Patients were bridged to LT with a median time of 8.4 months after SBRT, and 23.1% of them achieved a complete pathologic response. The median OS and RFS were 37.8 and 18.3 months from the time of LT, respectively.Conclusions: SBRT provides favorable tumor control and acceptable adverse effects for patients awaiting LT. Further prospective studies to test SBRT as a bridging therapy for LT are feasible.

Background : Stereotactic body radiotherapy (SBRT) is an effective but less focused alternative for treatment of hepatocellular carcinoma (HCC). To date, a personalized model for predicting therapeutic response is lacking. This study aimed to review current knowledge and to propose a radiomics-based machine-learning (ML) strategy for local response (LR) prediction. Methods : We searched the literature for studies conducted between January 1993 and August 2019 that used > 100 patients. Additionally, 172 HCC patients in our hospital were retrospectively analyzed between January 2007 and December 2016. In the radiomic analysis, 41 treated tumors were contoured and 46 radiomic features were extracted. Results : The 1-year local control was 85.4% in our patient cohort, comparable with current results (87-99%). The Support Vector Machine (SVM) classifier, based on computed tomography (CT) scans in the A phase processed by equal probability (Ep) quantization with 8 gray levels, showed the highest mean F1 score (0.7995) for favorable LR within 1 year (W1R), at the end of follow-up (EndR), and condition of in-field failure-free (IFFF). The area under the curve (AUC) for this model was 92.1%, 96.3%, and 99.2% for W1R, EndR, and IFFF, respectively. Conclusions : SBRT has high 1-year local control and our study sets the basis for constructing predictive models for HCC patients receiving SBRT.

Background: Stereotactic body radiotherapy (SBRT) is an emerging treatment modality for hepatocellular carcinoma (HCC) with promising outcome. However, appropriate survival prediction models are scarce. This study aimed to develop a simple and clinically useful prognostic nomogram for patients with nondistant metastatic Barcelona Clinic Liver Cancer (BCLC) stage C HCC undergoing SBRT. Methods: The data were based on a prospective multi-institutional registry enrolling 246 patients with nondistant metastatic BCLC stage C HCC treated with SBRT between January 1, 2008 and December 31, 2016. They were randomly divided into two subsets: 164 into the development cohort and 82 into the validation cohort. We identified and included prognostic factors for survival to derive a nomogram in the development cohort. The predictability of the nomogram was evaluated in the validation cohort. The area under the receiver operating characteristic curve (AUROC) and the calibration plot were used to evaluate the performance of the nomogram. Results: The median survival was 13.5 months, with 1- and 2-year overall survival (OS) rates of 55.0 and 32.9%, respectively. Number of tumors, largest tumor size, macrovascular invasion, Child-Turcotte-Pugh class, and biologically effective dose were significantly associated with OS (p < 0.05). These predictors were included to develop a nomogram with an AUROC of 0.77 (0.73–0.87). The prediction model was well calibrated in the validation cohort. The OS for patients who were divided by their risk scores differed significantly (p < 0.001). Conclusions: The nomogram we generated had discriminatory and satisfactory predictability for OS among nonmetastatic BCLC stage C HCC patients treated with SBRT. It demands further validations with cross-country data to confirm its worldwide usefulness.

Background: Radiotherapy has gained increasing attention as an effective cytotoxic agent to improve therapeutic response to immunotherapy. However, synergic effect is seldom seen clinically and reliable biomarkers for optimal patient selection remains to be identified. Radiosensitivity index (RSI) is a well-known measure of tumor’s response to radiotherapy, which is derived from genomic data and system biology. Its association with the immune landscape in cancer is unclear. Methods: Genomic data from Merged Microarray-Acquired dataset (MMD) were established and the Cancer Genome Atlas (TCGA) were obtained. Based on rank-based regression model including 10 genes, RSI was calculated. A total of 12,832 primary tumors across 11 major cancer types were analyzed. RSI was stratified into RSI-Low and RSI-High by a cutpoint of 0.46. Gene set variance analysis was applied to measure the genomic pathway activity (18 genes for T-cell inflamed activity). Kaplan-Meier analysis was performed for survival analysis. Findings: We found that RSI was significantly associated with homologous DNA repair, cancer stemness and various cancer-specific molecular features. Tumors with low RSI were associated with significantly higher portion of M1 macrophage, relative to M2 macrophage, and higher IFNG expression. Additionally, dominant interferon-γ (IFN-γ) response was characterized by low RSI and potentially predicted better response to programmed cell death 1 (PD-1) blockade. Interpretation: RSI is strongly associated with immune response and efficacy to PD-1 blockade. IFN-γ dominant status could be estimated by RSI, providing an alternative selection strategy to identify suitable patients for combined radiotherapy and immunotherapy. Funding Statement: This study was supported by study project of Tri-Service General Hospital (TSGH-D109063). Declaration of Interests: The authors declare that they have no competing interests.

OBJECTIVE:To evaluate the survival outcomes and prognostic factors of patients with advanced hepatocellular carcinoma (HCC) who underwent stereotactic ablative radiotherapy (SABR). METHODS:This retrospective study evaluated patients with advanced HCC who underwent SABR between December 2007 and July 2015. All patients had Barcelona Clinic Liver Cancer stage C disease and Child-Turcotte-Pugh (CTP) class A-B function. In-field control (IFC), overall survival (OS), prognostic factors, and toxicity were evaluated. RESULTS:In this study of 89 patients, the 3-year IFC rate was 78.1%, and the 1-year and 3-year OS rates were 45.9% and 24.3%, respectively. The multivariate analysis revealed that CTP class, the presence of main portal vein tumor thrombosis, and the presence of extrahepatic spread were independent predictors of OS. The expected median OS values among patients with ≥2, 1, and 0 predictors were 4.2, 8.6, and 26.4 months, respectively (p

To evaluate the prognostic performance of the Child-Turcotte-Pugh (CTP) score and the albumin-bilirubin (ALBI) score in hepatocellular carcinoma (HCC) patients treated using stereotactic ablative radiation therapy (SABR).This retrospective study evaluated the data of patients with HCC who underwent SABR between December 2007 and June 2015. We collected pretreatment CTP and ALBI scores and analyzed their correlation with survival and liver toxicity.This study included 152 HCC patients: 78.3% of CTP class A and 21.7% of CTP class B. The median ALBI score was -2.49 (range, -3.67 to -0.84) with 39.5% of grade 1, 56.6% of grade 2, and 3.9% of grade 3. The CTP classification and ALBI grade were significantly associated with overall survival (P.001). Albumin-bilirubin grade (1 vs 2) had a trend to stratify CTP class A patients into 2 risk groups of mortality (P=.061). Combined CTP class and ALBI score could predict development of radiation-induced liver disease (2.4% in CTP A-ALBI -2.76, 15.1% in CTP A-ALBI ≥ -2.76, and 25.8% in CTP B).Albumin-bilirubin score is a potential predictor for both survival and liver toxicity. Complementary use of CTP and ALBI score could predict the risk of post-SABR liver toxicity. Further prospective studies are necessary before use of the ALBI score can become part of daily practice.

The purpose of this study was to estimate the impact of metronomic therapy with oral tegafur-uracil (UFUR) following an intravenous FOLFOX regimen as surgical adjuvant chemotherapy on the overall survival (OS) and disease-free survival (DFS) of stage III colon cancer patients. From the retrospective database of patients who underwent a surgical resection for colorectal cancer at the Tri-Service General Hospital from October 2008 through December 2014, stage III colon carcinomas treated with radical R0 resection were reviewed. One hundred thirty two patients were treated with a FOLFOX regimen (comparison group), and 113 patients were treated with the same regimen followed by additional oral UFUR (UFUR group). The clinical characteristics and mean age of the comparison and UFUR groups were similar. Furthermore, for all study patients, DFS was not significantly different between the two groups. However, 5-year OS rates were 86.8% and 68.5% in the UFUR and comparison groups, respectively (p = 0.0107). Adding UFUR to a FOLFOX regimen was found to significantly improve the OS in patients with stage III colon cancer. UFUR as a maintenance therapy following FOLFOX regimen as an alternative therapeutic option for the treatment of stage III colon cancer patients.

Purpose We investigated whether lower urinary tract infection (LUTI), including cystitis or urethritis, is associated with an increased risk of developing prostate cancer (PCa), in a nationwide population-based cohort study. Methods We identified 14,273 men newly diagnosed with LUTI (9347 with cystitis, and 4926 with urethritis) between 1998 and 2011, from the Taiwan Longitudinal Health Insurance Database 2000. Each patient was randomly frequency-matched with 4 men without LUTI, based on age and index year of diagnosis. Cox’s proportional hazard regression analysis was performed to estimate the effect of LUTI on the PCa risk. Results The risk of developing PCa was significantly higher in the cystitis cohort (adjusted HR = 1.46, 95% CI = 1.20–1.78) and in the urethritis cohort (adjusted HR = 1.72, 95% CI = 1.26–2.34) than in the group without LUTI. Further analyses indicated that patients with more than 5 medical visits for LUTI per year had a significantly greater risk of developing PCa. Conclusion We found that cystitis or urethritis may play an etiological role in the development of PCa in Taiwanese men, particularly in those with repeated medical visits for cystitis or urethritis. Further studies are warranted on the association between LUTI and PCa in other countries, particularly where the prevalence of PCa is high.

Purpose The role of stereotactic ablative radiotherapy (SABR) in patients with unresectable or medically inoperable cholangiocarcinoma remains unclear. We examined the efficacy and safety of SABR in this group of patients. Methods From January 2008 to December 2014, 15 patients with 17 lesions were included in this study. The lesions included 14 intrahepatic, 1 hilar, and 2 distal bile duct tumors. Three patients were classified as medically inoperable because of old age or multiple comorbidities. Tumors measured 0.8-13 cm (median, 3.6 cm). The median prescribed dose was 45 Gy delivered in 5 fractions over 5 consecutive days. Results The median follow-up period for surviving patients was 29.9 months. Objective responses were observed for 10 of 17 tumors (58.8%), including 3 complete responses (17.6%). The median survival duration was 12.6 months, and the 1- and 2-year overall survival rates were 50.3% and 14.4%, respectively. The 1- and 2-year in-field failure-free rates were 61.5% and 30.8%, respectively. For patients with biologically effective doses (BEDs) exceeding 75 Gy10, the 1- and 2-year overall survival rates were 58.3% and 33.3%, respectively, compared to 20.0% and 0%, respectively for those with BEDs lower than 75 Gy10. Radiation-induced liver disease did not develop in any patient. Acute toxicities were generally mild and tolerable. Conclusions Stereotactic ablative radiotherapy could be an alternative treatment for unresectable or medically inoperable cholangiocarcinoma. Further dose escalation may be considered to optimize local control.

前言：肝癌病人如有合併門靜脈腫瘤栓塞存活率相當差。近年來許多證據支持立體定位消融放射治療可當作肝癌病人治療選擇，但是極少文獻報導關於肝癌合併門靜脈腫瘤栓塞使用立體定位消融放射治療之臨床結果及預後因子。材料與方法：本研究以回溯性的方式，篩選西元 2008 年至 2013 年於本部接受立體定位消融放射治療之 42 位肝癌合併門靜脈腫瘤栓塞病人，本部立體定位消融放射治療之執行是使用電腦刀影像導引立體放射手術系統（Cyberknife image-guided radiosurgery system (AccurayInc., Sunnyvale, CA)）。所有病患接受之平均劑量為 42.5 Gy, 每次照射 5-12.5 Gy。臨床與治療相關的因子皆會詳細記錄，包括年齡、美國東岸癌症臨床研究合作組織（Eastern Cooperative Oncology Group）體能狀態、甲種胎兒蛋白數值、Child-Pugh score、Cancer of the Liver Italian Program (CLIP) score、有無肝外轉移（extrahepatic metastasis (EM)）等等。治療後會依據追蹤的影像評估腫瘤反應，影像上腫瘤反應之評估是依據 Response Evaluation Criteria in Solid Tumors (RECIST) 此一準則。存活率的分析是使用 Kaplan-Meier 法。預後因子的分析則是使用 Cox 比例風險模式。結果：追蹤時間中位數為 7.8 個月，共有 38 名病患死亡，中位數存活期為 8.6 個月，第一年及第二年的整體存活率分別是 31.4%及 14.1%。9 名病患在還沒接受治療後第一次影像追蹤即死亡。在有接受任何一次治療後影像學評估的病患當中，腫瘤完全反應率（complete response）是 3%，部分反應率（partial response） 是 55%，疾病穩定率（stable disease）是 39.1%，而病情惡化率（disease progression）是 3%。9 名（21%）病患門靜脈有被打通且有接受後續肝動脈化學栓塞療法（transarterial chemoembolization）。單變量分析發現 Child-Pugh A (vs. B & C, HR = 0.470, p = 0.049)、CLIP score ≤ 3 (vs. ＞ 3, HR = 0.468, p = 0.046) 以及無肝外轉移（vs. presence of EM, HR = 0.497, p = 0.035）的患者會有較佳的整體存活率。多變量分析則發現無肝外轉移（vs. presence of EM, HR = 0.340, p = 0.015）是唯一有統計學意義的預後因子。結論：立體定位消融放射治療，是肝癌合併門靜脈腫瘤栓塞病患的一個治療選擇；無肝外轉移是唯一可以預測較佳整體存活的獨立預後因子。

The aim of the article is to analyze breast cancer patient clinical outcomes after long-term follow-up using intensity-modulated radiotherapy (IMRT) or conventional tangential radiotherapy (cRT). We retrospectively reviewed patients with stage 0–III breast cancer who received breast conserving therapy between April 2004 and December 2007. Of the 234 patients, 103 (44%) were treated with IMRT and 131 (56%) were treated with cRT. A total prescription dose of 45 to 50 Gy (1.8–2 Gy per fraction) was delivered to the whole breast. A 14 Gy boost dose was delivered in 7 fractions. The median follow-up was 8.2 years. Five of 131 (3.8%) cRT-treated patients and 2 of 103 (1.9%) IMRT-treated patients had loco-regional failure. The 8-year loco-regional failure-free survival rates were 96.7% and 97.6% (P = 0.393) in the cRT and IMRT groups, respectively, whereas the 8-year disease-free survival (DFS) rates were 91.2% and 93.1%, respectively (P = 0.243). Patients treated with IMRT developed ≥ grade 2 acute dermatitis less frequently than patients treated with cRT (40.8% vs 56.5%; P = 0.017). There were no differences in late toxicity. IMRT reduces ≥ grade 2 acute skin toxicity. Local control, DFS, and overall survival were equivalent with IMRT and cRT. IMRT can be considered a standard technique for breast cancer treatment.